In today’s show Dr. Oz invites a chronic pain specialist, Dr. Natalie Azar, to discuss her 3-step plan to end chronic pain. Dr. Natalie Azar explains why SNRIs and Pregabalin are good medication options for patients with chronic pain because they’re less addicting than Opioids. Dr. Azar ushers in a holistic view of chronic pain. She also gives holistic recommendations to address the pain problem as part of your overall wellness.
1) Chronic Pain Medication That Actually Work
Dr. Azar clarifies to all that for sure, there’s a place for Opioids in this country for cancer and acute pain cases. But what she’s addressing is chronic non-malignant pain, example chronic arthritic pain. What the medical community is able to show is that Opioids can be dangerous for addiction, overdoses and accidental deaths. So you would really like to stay away from Opioids because they have worse effects in the end.
One guest even shares her experience with Opioids prescription, “I feel groggy and nauseous, but the drug did not help get rid of my pain.”
The first question that Dr. Azar asks is, “Why do doctors easily prescribe these Opioids?” She explains that there is not 1 explanation. But mostly, it’s the patient that’s coming to the doctor for pain and they want quick relief without thinking of the long term functional consequences. They are not thinking about dependence when they go to see their doctors. They just want pain relief, so first, it’s patient-driven.
Secondly, it is also doctor-driven in a way that the patient keeps coming back to the doctor because the pain is still there. So it’s easier to fill out a prescription and see the patients leave, than actually having to deal with a multi-disciplinary team of doctors and therapists to treat the “whole” patient. It’s easier to write down a prescription that’s why Opioid use has become so popular in America.
At this point, Dr. Oz asks, “If you’re worried about Opioids, what medications do work?” She goes on to say that she’d like to use medicines that actually raise norpeniphrine in the brain. She recommends SNRIs and Pregabalin to chronic patients. SNRI is largely responsible for causing this pain syndromes and exacerbating pain signaling. Pregabalin works directly on the nerves as they are sending pain messages to the brain, and then they can stop that. Therefore, it is clear that we have new-generation medications that are better than, and aren’t as addictive, as Opioids.
2) Evaluate Your Sleep
Physicians first take the history of the patient who has complains of pain. One of the crucial questions Dr. Azar asks her patients is, “Do you feel tired?”
One-hundred percent of the time it’s yes.
The next question is, “When you wake up in the morning do you feel rested?” And this is a very key symptom: non-restorative sleep. Now, here is where the issue of pain lies. What comes first– chicken or the egg? So, is it poor sleep that’s exacerbating your pain OR is pain keeping you up at night? Now, there are pain specialists that say chronic pain is primarily a sleep problem actually. But what we do know is they go together. When you have a good night’s sleep, everything feels better the next day, and so the pain, too, is better.
We can see from this illustration that treating pain without addressing the underlying sleep problem is really doing the patient a disservice. It has to be looked at separately in connection to the whole pain picture. Not getting the quality sleep your body needs merits attention and careful examination.
When Dr. Azar sees these patients, 100% she recommends a sleep study for chronic pain patients. Sleep study is an overnight study where they monitor patient’s sleep pattern and identify what kind of poor quality sleep the patient is having. It can be sleep apnea that’s making the patient tired and then get a diagnosis. The sleep specialist also reviews things with patients. The doctor goes through sleep hygiene with them. The doctor may say something like, “You’re not supposed to take caffeine 2 hours before your bedtime, etc.”, to make sure patients are getting the best quality sleep that they can.
3) Establish a Mind-Body Connection
Dr. Azar describes to us how it’s a cycle: when you are feeling anxious and you are in pain, then the pain is going to make you depressed. And when depressed, patients tend to somaticize more. This means that they are even more aware of bodily sensations.
When the mind-body connection can be very negative for you, we try to flip it and do something like tai chi meditation, or yoga that can actually help connect you more and relax you more, and help you deal with these issues separately. After conditioning the mind-body connection, then she brings it all together.
Dr. Oz shows a diagram of the cycle that starts with chronic pain leading to insomnia, to more stressors, to depression, to chronic pain, leading to insomnia and around it goes back. This is a vicious cycle that’s making pain more chronic.
How to address this cycle? Dr. Azar explains there are studies that showed that people in chronic pain who are having depression are treated with pain medication. In their case, the pain is reduced but the depression is still there. Therefore, pain and depression go together, but they work in separate mechanisms. So if you do not treat depression, medication is not going to work. If you have anxiety and depression, those need to be addressed whether there’s a pain specialist or therapists. So it’s best that you deal with the depression, deal with the anxiety, and deal with the pain. Otherwise, the patient will just be incompletely treated. What we want now is to address the connection and treat the patient as a whole.
The topic in today’s show has never been timelier because of the widespread pain issues in America. Dr. Azar’s expert advice can give you some hope, because now we understand pain better and clearer than before. With proper understanding comes a proper remedy. Learn more about Chronic Pain in “The Body Doesn’t Lie” Book.